Bone is a specialised connective tissue and together with cartilage forms the strong and rigid endoskeleton. These tissues serve three main functions: scaffold for muscle attachment for locomotion, protection for vital organs and soft tissues and reservoir of ions for the entire organism especially calcium and phosphate. One of the most unique and important properties of bone is its ability to constantly undergo remodelling even after growth and modelling of the skeleton have been completed. Remodelling processes enable the bone to respond and adapt to changing functional situations. Bone is composed of various types of cells and collagenous extracellular organic matrix, which is predominantly type I collagen (85-95%) called osteoid that becomes mineralised by the deposition of calcium hydroxyapatite. The non-collagenous constituents are composed of proteins and proteoglycans, which are specific to bone and the dental hard connective tissues. Maintenance of appropriate bone mass depends upon the precise balance of bone formation and bone resorption which is facilitated by the ability of osteoblastic cells to regulate the rate of both differentiation and activity of osteoclasts as well as to form new bone. An overview of genetics and molecular mechanisms that involved in the differentiation of osteoblast and osteoclast is discussed.
MeSH terms: Bone and Bones; Bone Resorption; Calcification, Physiologic; Cartilage; Cell Differentiation; Ions; Locomotion; Osteoblasts; Osteoclasts; Osteogenesis; Proteoglycans; Durapatite; Collagen Type I
The potential of ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, in preventing central sensitization has led to numerous studies. Ketamine is increasingly used in the clinical setting to provide analgesia and prevent the development of central sensitization at subanaesthetic doses. However, few studies have looked into the potential of ketamine in combination with stress-induced analgesia. This study looks at the effects of swim stress, which is mediated by opioid receptor, on ketamine analgesia using formalin test. Morphine is used as the standard analgesic for comparison. Adult male Sprague-Dawley rats were assigned to 6 groups: 3 groups (stressed groups) were given saline 1ml/kg intraperitoneally (ip), morphine 10mg/kg ip or ketamine 5mg/kg ip and subjected to swim stress; 3 more groups (non-stressed groups) were given the same drugs without swim stress. Formalin test, which involved formalin injection as the pain stimulus and the pain score recorded over time, was performed on all rats ten minutes after cessation of swimming or 30 minutes after injection of drugs. Combination of swim stress and ketamine resulted in complete analgesia in the formalin test which was significantly different from ketamine alone (p<0.05) and saline with stress (p<0.01). There is no significant difference between ketamine stressed and morphine stressed. These results indicate that ketamine and swim stress act synergistically to produce profound analgesia in the formalin test. This suggests that in the clinical setting, under stressful situations such as operative stress, ketamine is capable of producing profound analgesia at a subanaesthetic dose.
Ninety two male brickfield workers and sixty sedentary individuals of 25-45 years were randomly selected from brickfields of West Bengal, India, to evaluate the body composition and hand grip strength among male brickfield workers and to compare the data with their sedentary counterparts. Assessment of body composition by skinfold measurements and determination of hand grip strength (HGS) by hand grip dynamometer indicated significantly higher (p<0.001) fatness, skinfold values and body mass index (BMI) among the sedentary individuals though HGS and hand grip endurance were significantly higher (p<0.001) among brickfield workers. BMI and %fat values indicated that the subjects were non-obese and non-overweight and regression norms for prediction of %fat from BMI in both the groups were computed as follows : Control Group : Y = 1.647 X - 22.789 (r = 0.92, p<0.001, SEE = 1.01), Brick-field Workers : Y = 0.747 X - 8.398 (r = 0.78, p<0.001, SEE = 1.34). Percentage of lean body mass (%LBM) was significantly higher (p<0.001) among brickfield workers whereas absolute LBM value had insignificant variation because of significant difference (p<0.001) in body mass between the groups. The present investigation revealed that the daily labour of the brick-field workers hindered the accumulation of body fat and extensive use of their hand and finger muscles enabled them to achieve greater arm strength. The proposed norms for prediction of %fat from BMI will also provide a first-hand impression about the body composition in the studied population.
Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.
We describe rare case of a 9-year old boy who presented with a two-week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme.
This short review explores the current status of cardiopulmonary resuscitation in Malaysia and highlights some of the factors that have a negative impact on its rate of success. Absence of a unifying body such as a national resuscitation council results in non-uniformity in the practice and teaching of cardiopulmonary resuscitation. In the out-of-hospital setting, there is the lack of basic skills and knowledge in performing bystander cardiopulmonary resuscitation as well as using an automated external defibrillator among the Malaysian public. The ambulance response time is also a significant negative factor. In the in-hospital setting, often times, resuscitation is first attended by junior doctors or nurses lacking in the skill and experience needed. Resuscitation trolleys were often inadequately equipped.
Hemolysis of erythrocytes from human and porcine blood was studied at different calcium chloride (CaCl(2)) concentrations (0.04-1.83 mM) and at a constant bilirubin concentration (72 mM). Although, human erythrocytes showed significant hemolysis (64%) at the highest CaCl(2) concentration (1.83 mM) used in this study, remarkable resistance to this phenomenon was observed with porcine erythrocytes as only 11% hemolysis was observed. A similar pattern in the behavior of both human and porcine erythrocytes was observed when parameter such as bilirubin concentration or time of incubation with bilirubin was varied. Other divalent cations such as Mn(2+), Ba(2+) and Mg(2+) were either least effective or ineffective in inducing hemolysis in presence of bilirubin. Serum albumin played a protective role in this phenomenon in a concentration dependent manner, as no hemolysis was observed at a bilirubin/albumin molar ratio of 1:1 or less. Differences in the structural make-up of proteins and lipids in the erythrocyte membranes of the two species may account for their different behavior.
This study was undertaken to evaluate the effects of n-3 fatty acid supplementation on blood glucose, lipid profile and cytokines in humans. Twenty adult healthy subjects were supplemented with 1g/day fish oil concentrate capsules for 2 weeks. Fasting blood samples were taken at baseline and again after 2 week intervention. Fish oil supplementation significantly lowered fasting serum concentrations of total cholesterol, triacylglycerol, very low density lipoprotein and low density lipoprotein (P < 0.01). Also high density lipoprotein increased significantly compared with baseline value (P < 0.01). Fish oil did not significantly altere the fasting blood glucose concentration but significantly reduced the serum cytokines (P < 0.001). This study demonstrated that eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA) supplementation altered serum lipids, lipoprotein and cytokine concentrations in normal human subjects even at the small dose of 660 mg of EPA plus DHA per day. It appears that EPA plus DHA can be a safe and perhaps beneficial supplement to inflammatory diseases.
Poor patient adherence to medication is one of the major factors contributing to poor disease control, in particular in asymptomatic chronic diseases like hypertension and dyslipidaemia. The physical and economic burden on patients and the health care system as a result of non-adherence is great. It is estimated that poor adherence to hypertension medication accounts for as many as 7.1 million preventable deaths annually. Hence recognising and identifying non-adherence is the first step to addressing this problem. Medication adherence can be measured in various ways including self-report to electronic monitoring. In order to be more successful in managing non-adherence, attention must be paid to barriers to adherence, namely the interplay of patient factors, the health care providers themselves and the health care system itself. Taking these into account will probably have the greatest impact on improving medication adherence. Consequently strategies to help overcome these barriers are of paramount importance. Some of these strategies will include education of patients, improving communication between patients and health care providers, improving dose scheduling, providing drugs with less adverse effects, and improving accessibility to health care. Poor mediation adherence continues to be a huge challenge. While the patient is ultimately responsible for the taking of medication, good communication, involving the patient in decision making about their care and simplifying drug regimens go a long way in improving it.
Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. The WHO in its report Preventing Chronic Disease: A Vital Investment has highlighted the inaction of most governments of the low and middle income countries in tackling the problem urgently, is clear and unacceptable. The acute care paradigm is no longer adequate for the changing pattern of diseases in today's and tomorrow's world. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases and its crushing burden resulting in escalating healthcare costs. Compelling evidence from around the world showed that there are innovative and cost-effective community-based interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. This paper describes the current situation of chronic disease management in the Malaysian primary care setting - to highlight the need for change, discuss the barriers to the implementation of effective chronic disease management programmes in the community, and consider fundamental solutions needed to instigate the change in our setting.
MeSH terms: Adult; Chronic Disease*; Humans; Malaysia
Qualitative data is often subjective, rich, and consists of in-depth information normally presented in the form of words. Analysing qualitative data entails reading a large amount of transcripts looking for similarities or differences, and subsequently finding themes and developing categories. Traditionally, researchers 'cut and paste' and use coloured pens to categorise data. Recently, the use of software specifically designed for qualitative data management greatly reduces technical sophistication and eases the laborious task, thus making the process relatively easier. A number of computer software packages has been developed to mechanise this 'coding' process as well as to search and retrieve data. This paper illustrates the ways in which NVivo can be used in the qualitative data analysis process. The basic features and primary tools of NVivo which assist qualitative researchers in managing and analysing their data are described.
Exercise-induced asthma (EIA) is a common condition affecting 12-15% of the population. Ninety percent of asthmatic individuals and 35-45% of patients with allergic rhinitis are afflicted by EIA, while 3-10% of the general population is also believed to suffer from this condition. EIA is a condition which is more prevalent in strenuous outdoor, cold weather and winter sports. The pathophysiology of EIA continues to intrigue medical physiologists. However, the water-loss hypothesis and the post-exertional airway-rewarming hypothesis are as yet the best accepted theories. EIA is best diagnosed by a good medical history and a free-run challenge test. A post-exertion decrease by 15% in FEV1 and PEFR is diagnostic of EIA. Sensitivity of exercise testing ranges from 55% to 80% while specificity is as high as 93%. EIA is a disorder that can be successfully treated by combining both non-pharmacological and pharmacological treatment options. Prompt diagnosis and treatment of this condition is vital if we hope to provide our patients with better overall health, better social life and a better self-image.
One thousand one hundred and sixty-nine (1169) patients were examined in the Eye Clinic of University of Malaya Medical Centre over a period of three weeks to determine the prevalence of eye diseases and visual impairment. Age, gender, race, visual acuity and diagnosis of patients were noted from the case records. Cataract (385, 32.9%) was the most common eye disease seen in our study followed by glaucoma (274, 23.4%). Refractive errors were seen in 126 (10.8%) while diabetic retinopathy was noted in 113 (9.7%) patients. One hundred and fifteen (9.6%) patients had visual impairment and 11 (0.9%) had blindness in our study according to WHO classification of visual impairment. Refractive errors are the most common causes of visual impairment in children, while cataract, glaucoma and diabetic retinopathy account for visual impairment in elderly people. All these eye diseases are treatable and the severe eye conditions may be potentially preventable with early diagnosis.
Study site: Eye Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The paper discusses the management of two individuals with asymptomatic hypertriglyceredemia, a common problem faces by Family Physicians in Malaysia. In such instances it is advisable to exclude an underlying disorder (e.g. metabolic syndrome) and take a pragmatic approach.
MeSH terms: Communication; Face; Humans; Malaysia; Physicians, Family
Leadership in a huge and complex organisation like the Ministry of Health is important. The importance of leadership lies in the role it plays in defining the character, values and direction of an organization; and it's relation to organizational performance. Leadership is a quality that must be embedded within an organization for the organization to be successful and meet its objectives. Good leaders can be developed through a continuous process of self-study, education, training and experience. This concept of leadership also highlights the importance of seeking people with leadership talent, developing their potential and providing opportunities for them to lead.
MeSH terms: Histological Techniques; Leadership; Organizations; Staff Development